Unicystic Ameloblastoma ? A Case Series

Ameloblastoma is a benign, locally aggressive neoplasm that constitutes about 1–3% of the tumors of the jaw. Wide surgical excision with adequate safe margin is the most common treatment of choice. The study aimed to manage cases with unicystic ameloblastoma while preserving the continuity of the mandible (without resection). This article presents a series of cases ranging from 18 to 40 years old patients of both sexes with unicystic ameloblastoma, especially in the mandible showing more male predilection than female. All the cases presented in this article were treated by enucleation and curettage. None of the patients presented post?operative paresthesia. None of the cases went in for resection. Post?operative recovery was uneventful in all the patients. All the patients were followed up for a period of 3.5–5 years. None of the cases reported recurrence at the date of publication.

Intelligent Energy-Aware Decision-Making At The Edge In Healthcare Using Fog Infrastructure

Modern cloud computing platforms are having trouble keeping up with the enormous volume of data flow generated by crowdsourcing and the intense computational requirements posed by conventional deep learning applications. Reduced resource consumption can be achieved by edge computing. The goal of the healthcare system is to offer a dependable and well-planned solution to improve societal health. Patients will be more satisfied with their care as a result of doctors taking their medical histories into account when creating healthcare systems and providing care. As a result, the healthcare sector is getting increasingly competitive. Healthcare systems are expanding significantly, which raises issues such massive data volume, reaction time, latency, and security susceptibility. Thus, as a well- known distributed architecture, fog computing could assist in solving

Molecular docking and cytotoxicity interactions of naringenin and its nano-structured lipid carriers in ER? positive breast cancer

Phytoestrogens are known to have beneficial properties in various carcinomas. They exhibit its efficacy at cellular levels. Naringenin a flavonoidal phytoestrogen is been explored for its antioxidant, cardio protective and cytotoxic function. The low absorbtion and poor bioavailability of naringenin makes it less efficient in targeting tumours at cellular levels. Due to the structural similarity of naringenin with estradiol and considering the affinity of naringenin with estrogen receptor, this study explores the interactions of naringenin on important signaling proteins involved in ER positive breast cancer through molecular docking studies and the prepared naringenin solid lipid nano particles were characterized and studied for its preventive potential against breast cancer cell lines. The lipidoid form of phytoestrogen shows promising cytotoxic potential compared with naringenin.

Assessment of physical activity and physical fitness among undergraduate medical students

Background: In a nationwide survey conducted in the Indian Council of Medical Research- INdia DIABetes study (Phase-1) 2014 on physical activity and inactivity patterns, overall, 392 million individuals in India are physically inactive. Physically active medical students tend to recommend physical activity for patients or at-risk individuals in their future practice. Exercise is a subset of physical activity that is planned, structured, and repetitive which helps in achieving physical fitness. Aim and Objectives: The aim of the study was to assess the prevalence of physical activity (PA) and physical fitness among medical students and to correlate both. Materials and Methods: This is a cross-sectional study, in which physical activity level was assessed using Global Physical Activity Questionnaire. Physical fitness using Harvard step test, hand grip dynamometer, sit-up and push-up test, shoulder – flexibility test, body mass index, and body adiposity index was assessed among 150 medical students in a tertiary care hospital. Results: Physical activity level when analyzed, 16% of students performed low PA, 74% belonged to moderate PA Group, and 10% in high PA group. When mean metabolic equivalent of task min/week attained by study population in three domains of physical activity (work/travel/recreation) was analyzed, results showed no significant difference between males and females in different domains of physical activity. Conclusion: Although the students met the recommended physical activity as per the World Health Organization, physical fitness was not achieved up to the desired level. No correlation was noted between physical activity and physical fitness among medical students.

"Proximal to distal" sequence of the release of the upper extremity post-burn contracture: Rule or case-based approach? / 中华创伤杂志(英文版)

Post-burn contractures are common entities seen in developing countries. There are multiple reasons for the development of contractures, most are preventable. In extensive contractures, a strategic plan is necessary to release all contractures and yet not antagonize post-operative positions. It is also necessary to be cost-effective and minimize the number of surgeries needed. Conventionally the release sequence in extensive burn contractures is proximal to distal. In this case report, we discuss an unusual sequence where we released distal contractures before the proximal to achieve optimum results. A 3-year-old child with post-burn contracture of hand, wrist, elbow, and axilla was treated in 2 stages, with the release of wrist contracture and cover with pedicled abdominal flap in the first stage and division of pedicled flap with the release of axilla and elbow contracture in the second stage. Thus, the release of all contractures was achieved without antagonizing post-operative positions and minimized the number of surgeries. A case-based approach may be crucial in making a strategic surgical plan to minimize the rehabilitation phase, rather than following known dictums.

A bolt from the blue in a testicular mass - continuous Splenogonadal fusion with maturation arrest

ABSTRACT Splenogonadal fusion is an infrequent cause of testicular or scrotal swelling with less than 250 cases reported. We report the case of a 27-year-old male who presented with painless scrotal swelling. The sonography showed a homogeneous, well-encapsulated left extratesticular mass, which was surgically removed. The gross examination revealed a grey-brown tissue below the left testis. The microscopy of the grey-brown mass revealed splenic tissue, and the testis showed maturation arrest, resulting in the diagnosis of splenogonadal fusion. These can be easily mistaken for a tumor, especially in this age group. Reporting such an entity increases awareness among clinicians, radiologists and pathologists, which will aid in preventing an orchiectomy for these patients.

Distribution and Association of Lip Print Pattern, Finger Print Pattern and ABO Blood Groups in Relation to Gender and Family Among South Indian Population

Background: Positive identification of living/ deceased using distinct traits is a cornerstone of forensic science. According to Locard’s principle “When two objects come into contact, there is always transfer of material from one to another”. The finger prints, lip prints and blood remains are the evidence for forensic identification. Aim: To study the frequency, distribution and association of ABO blood groups, finger print pattern, lip print pattern among gender and also the inherent nature of patterns among family members. Materials and Methods: A total of 200 Subjects (100 males, 100 females) within the age range of 17- 30 years and 20 families were randomly selected and aggregated as groups. Lip prints and finger prints were collected using dusting technique with fine carbon powder. ABO blood group was determined by slide agglutination method. Results: Ulnar loop - Males - Vertical, Radial loop - Males - Branching, Whorl - Females - Branching, Arch - Males - Intersecting; Females - Vertical. O positive, B positive - Loop - Branching, A positive - Loop - Vertical and Intersecting, AB positive - Whorl - Branching and Intersecting. Among 20 families, 14 families showed 100 percent pattern resemblance. High percentage of similar pattern was observed between father to daughter (70%) in finger prints and mother to son in lip prints (71%). Conclusion: Correlating the uniqueness of these physical evidence helps in personal identification as it can narrow the search & to substantiate the facts where there is little evidence

Association of anemia and hypoalbuminemia with mortality among patients undergoing routine hemodialysis

Background:The progressivity of chronic kidney disease (CKD) is associated with several clinical conditions which contribute to high morbidity and mortality, including anemia and hypoalbuminemia. This study aimed to assess the association of anemia and hypoalbuminemia with the mortality of CKD patients undergoing routine hemodialysis (HD) in Siloam Hospital Kupang.Methods:We conducted a retrospective cohort study based on Indonesia renal registry data system and hospital medical records. We studied the following variables: gender, age, etiology of CKD, vascular access of HD, and prevalence of anemia and hypoalbuminemia. All analysis was performed using SPSS software version 22.Results:There were 128 patients enrolled in this study. Of the total patients who died, most of them died within the first 3 months since the initiation of HD (62.1%). The majority of patients had anemia (67.2%) and hypoalbuminemia (69.5%). The bivariate analysis showed that anemia (p value=0.192), and hypoalbuminemia (p value=0.336) were notstatistically significant associated with mortality among patients undergoing routine HD.Conclusions:Anemia and hypoalbuminemia are not statistically associated with mortality outcome of CKD patients in Siloam Hospital Kupang. However, these conditions may still have prognostic importance for CKD patients undergoing routine HD. Further studies with larger size of cohort and longer period of time are warranted.

Reduced Heart Rate Variability as A Risk Factor for Cardiovascular Disease in Young Healthy Adults with Low and High Body Mass Indexes – A Descriptive Study

Background: Heart rate variability (HRV) is a used to assess autonomic nervous system input to the heart. Studies on the impact of HRV on underweight are limited. Aims/Objectives: To evaluate HRV in age matched young adults of different BMI category. Methodology: This cross-sectional study was done among healthy young adult volunteers between 18 and 25 years of age. Anthropometric variables were measured. ECG was recorded in lead II configuration for 5 minutes. Heart rate variability was analysed with Kubios HRV analyzer. Results: HRV indices were reduced in underweight (UW), overweight (OW) and obese group compared to normal weight (NW) BMI group. Second order polynomial regression between BMI and HF log power in both genders shows an inverted U-shaped relationship with BMI. The association between BMI, waist circumference and body fat (percentage) with HRV indices shows a significant relation to heart rate var-iability among which waist circumference (WC) shows a greater association with HRV indices than BMI. Comparison of HRV parameters among men and women of different BMI group shows female had great-er heart rate variability compared to males across BMI Conclusions: underweight individual also have increased cardiovascular risk like obese group and ab-dominal obesity is better indicator of cardiovascular risk than BMI.

Analysis of the relation between elevated neutrophil lymphocyte ratio, and erythrocyte sedimentation ratein Helicobacter pyloripositive chronic gastritis patients

Background:Aim of the study was to analyse the relation between elevated neutrophil lymphocyte ratio (NLR), and erythrocyte sedimentation rate (ESR) in Helicobacter pylori(H. pylori)positive chronic gastritis patients, as compared to the control group containing H. pylorinegative chronic gastritis patients.Methods:Chronic gastritis patients were segregated in equal numbers based on H. pyloristatus. NLR was calculated, and ESR noted from the observations, comparison was done between the control and the study groups.Results:A total of 100 patients were included in the study. The 50 each from the control and study group. An observation of elevation in NLR and ESR in H. pyloripositive chronic gastritis patients, as compared to the control group was seen. With an average NLR of 2.43 and 1.43, in the control and study group, respectively.Conclusions:Raise in NLR in H. pyloripositive chronic gastritis patients with an associated raise in ESR suggests, the severity of the infection and the need for eradication and prevent complications

A rare case of pancreato-pleural fistula with left sided massive pleural effusion

Pancreaticopleuralfistula is a very rare complication of acute and chronic pancreatitis. High index of suspicion is needed to diagnose in patients with alcohol induced pancreatitis, presenting with recurrent or persistent pleural effusion. Patient typically presented with pulmonary symptoms, rather than abdominal complaints, leading to delay in the diagnosis. Here we present a case of a known chronic pancreatitis who presented to us with massive left sided pleural effusion. Blood coloured pleural fluid analysis showed lipase and amylase levels in hundred thousand and ten thousand ranges. Diagnosis was made by CECT abdomen and confirmed with MRCP. Patient was treated with first line medical management of thoracocentesis and ERCP with pancreatic duct stenting.

A correlation of disease severity and outcome with malnutrition status in adults with COVID-19

Background: Coronavirus disease 2019 (COVID-19) pathology increases catabolism and depletes the protein stores, causing malnutrition. However, nutrition assessment in COVID-19 is often overlooked in the current pandemic. The Controlling Nutritional Status (CONUT) score is a validated score to assess nutritional status in hospitalized patients. The objective of the study was to estimate malnutrition among hospitalized adult patients with COVID-19 using the -The Controlling Nutritional Status (CONUT) score and study itseffect on the disease severity and outcomes. Methods:The study was a retrospective study on 146 patients with COVID-19. The history, demographic details were noted and the following parameters were noted at baseline and time of outcome-COVID-19 disease severity, radiological severity, CONUT score, inflammatory markers-serum LDH, CRP, Ferritin, D-Dimer. The outcome parameters-mortality, duration of hospital stay and severity of disease at outcome were measured. Results: Out of the 146 patients, 84 (57.53%) were male and 62 (42.47%) were female. 97.26% patients had malnutrition at baseline with 42 (28.77%) mild, 70 (47.95%) moderate and 30 (20.55%) severe malnutrition based on CONUT score. The CONUT scores were greater at outcome compared to baseline (p<0.001). Higher grades of malnutrition were associated with greater baseline and outcome disease severity (p<0.001), radiological severity (p<0.001), higher levels of inflammatory markers (p<0.001) and a higher mortality (p<0.001). However, there was no significant difference in duration of hospital stay (p=0.67).Conclusions: Malnutrition results in worse outcomes and greater mortality in COVID-19. Individual tailored nutritional support in the hospitalized COVID-19 patients, can thus potentially improve outcomes.

Intramuscular hemangioma of the masseter muscle:a case report

Background - Intramuscular hemangiomas are benign vascular tumours that most frequently occur in the trunk and extremities.They constitute about <1% of all hemangiomas, only 10%–20% have been found to arise in the head and neck region, and 36% of cases involving masseter muscle.They usually present as gradually enlarging soft-tissue mass with or without pain. They are located deep within the muscle, hence rarely exhibit clinical signs or symptoms such as bruits, thrills, pulsation which are suggestive of vascular origin. Due to their rare occurrence, unique location they are often confused with other soft-tissue pathologies such as parotid swelling or other muscular lesions. Case report - 21 year old male came with complaints of swelling and pain over the left cheek for past 6 months which was insidious in onset and non progressive.Patient did not have any history of trauma or increased salivation.On examination swelling of about 2*2 cm over the left cheek,well defined,non tender,soft in consistency.There was no pulsation,bruits or palpable thrill.There was no compressibility and the overlying skin was normal.There was no facial nerve involvement and parotid duct orifice was normal. Conclusion - The possibility of an Intramuscular hemangioma of the masseter muscle should be included in the differential diagnosis of any intra-masseteric lesion. Appropriate radiologic examinations, especially MRI, can enhance accurate preoperative diagnosis; the treatment of choice should be individualized in view of the clinical status of the patient.

Drug - Drug Interactions among Chronic Kidney Disease patients in a tertiary hospital.

Background: Drug interaction (more precisely ‘drug-drug interaction’) refers to modifying the action of one drug by another when administered simultaneously or in quick succession. Chronic Kidney Disease (CKD) patients often require polypharmacy, which puts them at the risk of the developing Drug - Drug Interactions (DDIs) and various adverse reactions. Not all patients taking interacting drugs experience adverse consequences, but it is advisable to take due precautions to avoid mishaps in all cases where interactions are possible. Hence, this study was undertaken to identify the DDIs among the drugs prescribed to CKD patients. Materials and methods: A Cross-sectional study was conducted in the Department of Nephrology. A total of 80 patients with CKD were included. Patients with CKD with other comorbid conditions, CKD patients of either sex above the age group of 18 years were included. LEXICOMP drug interaction software was used for potential DDI (pDDI) identification. Results: Patients mean age was 47.24±14.37 years with male predominance of 72.5 %. A total of 604 drugs were prescribed with a mean of 7.55 ± 2.73. The most common medications prescribed was Amlodipine (6.3%). DDIs were identified in 74 patients. 46 showed 1 to 5 pDDIs, 22 patients showed 6 to 10 p DDIs, 4 patients showed 11 - 15 DDIs, and 2 patients showed 16 to 20 pDDIs. According to the Lexicomp severity classification, 270 were Type C, 57 were Type D & 55 were Type B. Conclusion: The recognition of potential DDI and key combinations of drugs avoids treatment failure situations or minimizes drug toxicity .

A Study On Variations In Origin And Course Of Right Hepatic Artery

Background: With ever increasing load of liver disease on population of developed as well as developingcountries, it has become mandatory to have a detailed knowledge about hepatic arteries. Since adequate literatureregarding hepatic arteries and its variation e in people living in and around Eluru is not available, a study ofhepatic arteries ad its variation is carried out in our ASRAM medical college, Andhra Pradesh, India.Aims and objectives: To study the variations in the origin, course of right hepatic arteryMaterials and methods: This study was conducted in 60 embalmed adult cadavers of both sexes of age groupbetween 50 to 80 years. The common hepatic artery and its branch gastroduodenal artery were identified. Properhepatic artery in the hepatoduodenal ligament was traced and the relation of the common hepatic artery and theproper hepatic artery were noted. Origin of the RHA was traced and the presence of aberrant right hepaticarteries: (i) Replaced; (ii) Accessory were noted. To identify the presence of aberrant right hepatic arteries,abdominal aorta was exposed from the level of origin of the coeliac trunk to the level of origin of the inferiormesenteric artery.Results: In this study, the right hepatic artery originates from the proper hepatic artery in 24 (60%) specimens.Theaberrant, accessory and replaced right hepatic artery were found to be 20%, 12.5%, and 7.5% respectively. 5% ofspecimen showed caterpillar hump in right hepatic artery.Conclusion: Right hepatic artery is subject to anatomical variation in its origin and course. Because of anatomicvariations in the RHA, surgical injuries in the liver can occur even by the most experienced surgeon. A thoroughknowledge of the RHA anatomy is necessary while performing hepatic surgery and hepatic arteriography

Infusing the axioms of clinical reasoning while designing clinical anatomy case vignettes teaching for novice medical students: a randomised cross over study / 대한해부학회지

The clinical reasoning skills is often gained when the biomedical knowledge is broadened and deepened alongside exposure to patients. The ‘ideal’ blend of axioms of clinical reasoning and case based learning would establish the pedagogical bridges right from the first year of medical education. So this study aimed to investigate the perceived importance and efficacy of teaching clinical reasoning skills among first year medical students, as this has not previously been described. As a priori, two clinical reasoning skill sessions were conducted using clinico-anatomical case vignettes designed according to the literature regarding clinical reasoning (‘serial cue’ approach and hypothetico-deduction). Students were divided into intervention and control group and crossed over in subsequent sessions. Analysis was done by mixed method approach including measuring proof of benefit using post-test comparison, quantitative survey and qualitative analysis by nominal group discussion. Post test scores were compared using student’s t-test. Feedbacks were analysed using descriptive statistics. The results showed that post test scores were significantly higher in intervention group than the control group in both sessions (P<0.001, 0.016). A total of 66% students felt, diagnostic skills and lateral thinking abilities were improved and It helped in developing problem-solving abilities for 67% students. clinico-anatomical case vignettes helped in understanding anatomical basis of clinical conditions for 61% students. To conclude, introducing clinical reasoning has considerable effect in improving the decision making ability of the students and if incorporated right from the first year, would better prepare the students in successful transition to clinical learning environment.

Infusing the axioms of clinical reasoning while designing clinical anatomy case vignettes teaching for novice medical students: a randomised cross over study / 대한해부학회지

The clinical reasoning skills is often gained when the biomedical knowledge is broadened and deepened alongside exposure to patients. The ‘ideal’ blend of axioms of clinical reasoning and case based learning would establish the pedagogical bridges right from the first year of medical education. So this study aimed to investigate the perceived importance and efficacy of teaching clinical reasoning skills among first year medical students, as this has not previously been described. As a priori, two clinical reasoning skill sessions were conducted using clinico-anatomical case vignettes designed according to the literature regarding clinical reasoning (‘serial cue’ approach and hypothetico-deduction). Students were divided into intervention and control group and crossed over in subsequent sessions. Analysis was done by mixed method approach including measuring proof of benefit using post-test comparison, quantitative survey and qualitative analysis by nominal group discussion. Post test scores were compared using student’s t-test. Feedbacks were analysed using descriptive statistics. The results showed that post test scores were significantly higher in intervention group than the control group in both sessions (P<0.001, 0.016). A total of 66% students felt, diagnostic skills and lateral thinking abilities were improved and It helped in developing problem-solving abilities for 67% students. clinico-anatomical case vignettes helped in understanding anatomical basis of clinical conditions for 61% students. To conclude, introducing clinical reasoning has considerable effect in improving the decision making ability of the students and if incorporated right from the first year, would better prepare the students in successful transition to clinical learning environment.

Malignant nodular hidradenoma-inguinal region clinically masquerading as squamous cell carcinoma: a case report

Malignant Nodular hidradenoma is an extremely rare aggressive tumour originating from eccrine sweat glands with an incidence of <.001%. So far less than 80 cases have been reported in the literature. It’s known for its local recurrence (50%) and metastasis (60%) and hence early diagnosis and radical treatment is mandatory. But differentiating it from its benign counterparts and other skin tumour mimics is challenging, due to its histopathological similarity & lack of diagnostic immunomarkers. Authors report a case of 65-year-old female who presented with a short 4-month history of rapidly growing ulceroproliferative growth in the right inguinal region with bilateral inguinal node enlargement, associated with pain and discharge. Wedge biopsy of left inguinal lymph node showed malignant cutaneous adnexal tumour deposits, which after excision was typed as malignant nodular hidradenoma. It was confirmed with immunohistochemistry. Patient presented with recurrence 8 months after excision.

Role of hysterolaparoscopy in unexplained infertility

Background: Infertility, as defined by World Health Organization (WHO), is failure to achieve pregnancy during 1 year of regular unprotected intercourse. The objective of this study was to determine the incidence of unsuspected pathology at hysterolaparoscopy in presumed unexplained infertility, the incidence of intervention done for correcting pathology and its outcome and the importance of hysterolaparoscopy in the evaluation and treatment of infertile couples.Methods: This prospective observational study was carried out at IVF and Endoscopy centre, Department of obstetrics and gynecology at the Ruby Hall clinic, Pune from 1st November 2014 to 30th July 2016, after obtaining institutional ethical clearance and who met the inclusion and exclusion criteria. A detailed clinical history and physical examination and bimanual pelvic examination were done, following which all the patients were subjected to baseline blood investigation, 3D pelvis (TVS) and semen analysis. Day care hysterolaparoscopy was performed and systematic analysis were done.Results: The mean duration of infertility was 2 to 4 years. In our study out of 75 women 62 (82.67%) showed normal hysteroscopic findings, remaining 13 women (17.67%) showed abnormal hysteroscopic findings like cornaul blockage, intrauterine adhesions and tuberculosis endometrium. Abnormal laparoscopic findings were reported in 29.33% of which the most common pathology was endomertiosis (21.33%).Conclusions: Diagnostic Hysterolaproscopy is a safe, effective, minimally invasive, cost effective, daycare comprehensive procedure in evaluation of unexplained infertility. Apart from routine diagnostic protocol missed pathologies can be detected and this tool can be used for diagnostic as well as therapeutic intervention.

Universal screening for hypothyroidism in pregnancy: is it necessary?

Background: Thyroid diseases are one of the commonest endocrine disorders affecting women of reproductive age group, and hence constitute one important disorders complicating pregnancy. The objective of this study was to determine the importance of universal screening for hypothyroidism in pregnancy at the first antenatal visit and to formulate whether this routine screening is mandatory in our country.Methods: This retrospective study was conducted in the year 2018 at PSG IMSR Hospital for all pregnant women who attended the first antenatal visit between Jan 2012 to Dec 2012 after obtaining ethical clearance. Pregnant women who were already taking treatment for hypothyroidism, diabetes mellitus, hypertension and those pregnant women who lost their follow up were excluded from the study.Results: The incidence of subclinical hypothyroidism among antenatal women were 7.06%. In our study the maternal complications like anemia 12 (8%), preeclampsia 26 (17.3%), gestational diabetes 25 (16.7%), fetal growth restriction 8 (5.3%), Oligohydramnios 13 (8.7%), pre mature rupture of membranes 25 (16.7%), placental abruption in 2 (1.33%), APLA syndrome 2 (1.33%), low birth weight 26 (17.3%) were observed.Conclusions: Universal screening for hypothyroidism is recommended for all antenatal women especially in iodine depleted country like India.